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Upper portion of cardiac silhouette formed by dilated right and left superior venae cavae. Under cardiopulmonary bypass, the confluence of pulmonary veins, which lies directly behind the left atrium, is opened and connected to it (Figure 6. This operation can be performed with low risk, even in neonates and younger infants. Summary Each of the anatomic types of total anomalous pulmonary venous connection is associated with cyanosis of variable extent. The physical findings are those of atrial septal defect; pulmonary hypertension may also be found. Both the electrocardiogram and the chest X-ray reveal enlargement of the right-sided cardiac chambers. Corrective operations can be performed successfully for each of the forms of total anomalous pulmonary venous connection. Obstruction is always present in patients with an infradiaphragmatic connection and occasionally in patients with a supradiaphragmatic connection. In the latter, obstruction may occur intrinsically from narrowing of the channel or extrinsically if the channel passes between the bronchus and the ipsilateral branch pulmonary artery. In infradiaphragmatic connection, four mechanisms contribute to obstruction in pulmonary venous flow: (1) the venous channel is long; (2) the channel traverses the diaphragm through the esophageal hiatus and is compressed by either esophageal or diaphragmatic action; (3) the channel narrows at its junction with the portal venous system; and (4) the pulmonary venous blood must traverse the hepatic capillary system before returning to the right atrium by way of the hepatic veins. Consequently, pulmonary capillary pressure is raised, leading to pulmonary edema and a dilated pulmonary lymphatic system. Pulmonary arterial pressure is elevated because of both elevated pulmonary capillary pressure and reflex pulmonary vasoconstriction. Because of the pulmonary hypertension, the right ventricle remains thick walled, does not undergo its normal evolution following birth, and remains relatively noncompliant. Because of the reduced pulmonary blood flow, the patients show more intense cyanosis than those with without pulmonary venous obstruction. The clinical features of total anomalous pulmonary venous connection with obstruction relate to the consequences of pulmonary venous obstruction and to the limited pulmonary blood flow. Patients with obstruction present as neonates with significant cyanosis and respiratory distress. The cyanosis is accentuated by the pulmonary edema that interferes with oxygen transport from the alveolus to the pulmonary capillary. Respiratory symptoms of tachypnea and dyspnea result from the altered pulmonary compliance from pulmonary edema and hypertensive pulmonary arteries. Cyanosis is present, and increased respiratory effort is manifested by intercostal retractions and tachypnea. Since the volume of flow through the right side of the heart is normal, no murmurs appear. The accentuated pulmonic component of the second heart sound reflects pulmonary hypertension. The cyanosis without cardiac findings of these neonates usually suggests a pulmonary rather than a cardiac condition. Beyond the immediate neonatal period, the infants appear scrawny and malnourished. Right ventricular hypertrophy, right-axis deviation, and right atrial enlargement are found. Therefore, the electrocardiograms of neonates with obstructed pulmonary venous connection appear similar to those of normal neonates. Cardiac size is normal because the volume of systemic and pulmonary blood flows is normal. Even in young children, Kerley B lines, which are small horizontal lines at the margins of the pleura mostly in the lower lung fields, are present. The radiographic pattern, although similar to that of hyaline membrane disease, differs from it because it does not usually show air bronchograms. In both, the patients present with respiratory distress and cyanosis in the neonatal period.

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Note that echogenicity of the muscle perpendicular to ultrasound beam in near and far fields is greater than that seen in lateral aspects of thickened pyloric muscle. Ultrasound shows characteristic "target sign" on transverse section: hypoechoic ring with an echogeniccenter. E A 7-year-old boy with a limp and osteonecrosis of left proximal femoral epiphysis. The"saggingrope"sign(arrow),producedbytheoutlineof an abnormally oriented physis, indicates growth arrest. Skipmetastasis(arrow)isalsoseenonatechnetium-99mmethylenediphosphonate bone scan (B) and is shown as a cortical-based intramedullary lesion (arrow) on a coronal T1-weighted magnetic resonance image (C). Lamellarperiostealreactionandnewbone formation are present, with Codman triangles at proximal and distal ends of tumor. Computed tomography and radiation risks: what pediatric health care providers should know. Pericarditis: documented by electrocardiogram or rub or evidence of pericardial effusion 1. Clinicalandlaboratoryfeatures: (1) Thrombocytopenia,hemolyticanemia (2) Inflammatoryfeaturesofneonatallupuswillresolvewithin6 monthsasmaternalautoantibodiesarecleared (3) Congenitalheartblock(associatedwithanti-Ro):Permanent condition;usuallyrequirespacemakerplacement (4) Commoncauseofhydropslikelysecondarytoheartblockor Coombsantibody-mediatedimmuneanemia C. Twoformsofpediatricsarcoidosis: (1) Beforepuberty(usually<age4):Maybefamilial;dominatedby skin,musculoskeletal,andeyeinvolvement (2) Duringorafterpuberty:Verysimilartoadultdisease;dominated bylung,lymphatic,eye,andsystemicinvolvement d. Localized(limited)scleroderma: (1) Morecommonthansystemicdisease (2) Clinicalmanifestations: (a) Morphea:Discretecutaneouslesionsofvaryingsize, characterizedbyhypopigmentationandindurationsurrounded byhyperpigmentedskin. Canbepositiveinnonrheumaticdiseases: (1) Neoplasm (2) Infections(transientlypositive):Mononucleosis,endocarditis, hepatitis,malaria. A multicenter case-control study on predictive factors distinguishing childhood leukemia from juvenile rheumatoid arthritis. Anti-cyclic citrullinated peptide antibodies in patients with juvenile idiopathic arthritis. Juvenile dermatomyositis and other idiopathic inflammatory myopathies of childhood. Please use great caution and be aware of this limitation when interpreting pediatric laboratory studies. The following values have been compiled from both published literature and the Johns Hopkins Hospital Department of Pathology. Consult your laboratory for its analytic method and range of normal values, and for less commonly used parameters which are beyond the scope of this text. A special thanks to Lori Sokoll, PhD, and Allison Chambliss, PhD, for their guidance in preparing this chapter. All of the following criteria do not have to be met for consideration as an exudate. Cerebrospinal fluid evaluation in neonates: comparison of high-risk infants with and without meningitis. Apply the Evidence to the Clinical Question: Iftheevidenceisvalidandimportant,integrateitwithyourclinical expertiseanddecidewhether: 1. X mg Write "morphine sulfate" Write "magnesium sulfate" *Applies to all orders and all medication-related documentation that is handwritten (including free-text computer entry) or on preprinted forms. Exception: A "trailing zero" may be used only where required to demonstrate the level of precision of the value being reported, such as for laboratory results, imaging studies that report size of lesions, or catheter/tube sizes. B Animal studies have not demonstrated a risk to the fetus, but there are no adequate studies in pregnant women; or animal studies have shown an adverse effect, but adequate studies in pregnant women have not demonstrated a risk to the fetus during the first trimester of pregnancy, and there is no evidence of risk in later trimesters. For oral administration, chilling the solution and mixing with carbonated beverages, orange juice, or sweet drinks may enhance palatability. A mild transitory warm or stinging sensation of the skin may occur during the first 4 weeks of use. When compared to isotretinoin in a clinical trial for nodulocystic acne, adapalene+benzoyl peroxide plus doxycycline was not inferior to isotretinoin and was less effective in reducing the number of total lesions (nodules, papules/pustules, and comedones). Possible side effects include tachycardia, palpitations, tremors, insomnia, nervousness, nausea, and headache.

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Survival, incidence, and all causes of mortality were assumed to be constant from 2016 through 2030. This method considers geographic variations in sociodemographic and lifestyle factors, medical settings, and cancer screening behaviors as predictors of incidence, and also accounts for expected delays in case reporting. This report presents relative survival rates to describe cancer survival for selected cancers. Relative survival adjusts for normal life expectancy (and events such as death from heart disease, accidents, and diseases of old age) by comparing survival among cancer patients to that of people not diagnosed with cancer who are of the same age, race, and sex. Data are only collected for patients diagnosed or treated at CoC-accredited facilities, which are more likely to be located in urban areas and tend to be larger centers compared to non-CoC-accredited facilities. Additionally, cancers that are commonly treated and diagnosed in non-hospital settings. Factors associated with return to work of breast cancer survivors: a systematic review. Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship. Breast and colon cancer patient perceptions of the management of cancer-related pain, fatigue and emotional distress in community oncology. Life after diagnosis and treatment of cancer in adulthood: contributions from psychosocial oncology research. The rationale for patientreported outcomes surveillance in cancer and a reproducible method for achieving it. Disparities in stage at diagnosis, treatment, and survival in nonelderly adult patients with cancer according to insurance status. Factors That Contributed to Black-White Disparities in Survival Among Nonelderly Women With Breast Cancer Between 2004 and 2013. Racial and Ethnic Disparities in Cancer Survival: the Contribution of Tumor, Sociodemographic, Institutional, and Neighborhood Characteristics. Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States. Randomized trials of breast-conserving therapy versus mastectomy for primary breast cancer: a pooled analysis of updated results. A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Bilateral Mastectomy versus Breast-Conserving Surgery for Early-Stage Breast Cancer: the Role of Breast Reconstruction. State Variation in the Receipt of a Contralateral Prophylactic Mastectomy Among Women Who Received a Diagnosis of Invasive Unilateral Early-Stage Breast Cancer in the United States, 2004-2012. Survival analysis of contralateral prophylactic mastectomy: a question of selection bias. Benefits and risks of contralateral prophylactic mastectomy in women undergoing treatment for sporadic unilateral breast cancer: a decision analysis. Survival outcomes after contralateral prophylactic mastectomy: a decision analysis. National Breast Reconstruction Utilization in the Setting of Postmastectomy Radiotherapy. Disparities in breast cancer outcomes between Caucasian and African American women: a model for describing the relationship of biological and nonbiological factors. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and metaanalysis. Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. Prevalence of pain in patients with breast cancer post-treatment: A systematic review. Predictors of persistent pain after breast cancer surgery: a systematic review and metaanalysis of observational studies. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. Interventions to Address Sexual Problems in People With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline. Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: a systematic review.

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All of the eligible abstracts identified were presented in the year 2008; otherwise eligible abstracts presented in prior years were excluded because the studies they represented were subsequently published in full reports. The 12 abstracts represent 923 patients; despite our attempt to exclude studies that overlapped entirely with fully published reports, it is likely that some of the 923 patients represented in the abstracts listed in Table 15 are represented in the fully published reports summarized elsewhere in this report. One of the studies presented as an abstract compared a transapical approach (n = 21) with sternotomy (n = 30) in a series of 51 consecutive patients. Three abstracts specified that they used a transapical approach, and six used the term "percutaneous" or "transcatheter" without specifying which specific approach was used. None of the studies represented by the meeting abstracts were conducted in the United States; all were conducted in Europe. Pulmonary valve insufficiency is the clinical indication for the former, whereas the latter two are enrolling patients with either "heart valve disease" or "aortic valve disease. Registries Our systematic search of the published literature and our extensive search of the gray literature did not identify any ongoing or recently-closed-but-as-yet-unpublished registries of percutaneous heart valves. Variables that May Affect Outcomes for Percutaneous Heart Valves the evidence derived from the 62 fully published reports identified by our search strategy that pertains to the 6 categories of variables identified above is summarized in the sections that follow. Prosthesis Characteristics Five of the seven companies identified as percutaneous heart valve manufacturers are each represented by a single report in the published literature. Four of these are case reports,98100,102 and one is a case series involving 15 patients;101 none of the five reports included a direct comparator. This is insufficient evidence to comment on potential relationships between the design or manufacturer of a valve and clinical outcomes for these devices. These data do not support definitive conclusions regarding the possible superiority of one of these devices over the other. Given the absence of an experimental design or direct control group, comparisons across studies are limited by numerous confounding factors, including patient and operator characteristics, clinical indication for the procedure, treatment setting, and secular trends. The inability to distinguish between causative and confounding factors applies to all of the variables considered here that may theoretically impact clinical outcomes associated with percutaneous heart valve replacement. Larger catheter sizes may limit patient eligibility due to insufficient iliac artery size; they are also associated with greater risk of vascular trauma to iliac or aortic arteries. The potential relationship between decreasing catheter size and improved clinical outcomes is illustrated by the study by Grube et al. It is possible, however, that the improved outcomes observed over time in the series of patients reported in this study are due to factors independent of the smaller catheter size, such as operator experience with the procedure or other variables that may have changed over time. Although clearly important for approaches that involve cannulation of major vessels, the size of the delivery system catheter is theoretically less important for the transapical approach. There is also a theoretical advantage of devices that permit either post-deployment adjustment or intraoperative deployment of a second percutaneously delivered heart valve within a malpositioned prosthetic valve. The femoral vein approach offers the theoretical advantage of femoral venous rather than arterial access, potentially reducing complications related to injury to arterial vessels. In this approach, a catheter is introduced through the groin into the femoral vein, and then maneuvered to the right atrium and across the intra-atrial septum and mitral valve to reach the aortic valve. This approach carries the risk of residual atrial septal defect from the large delivery catheter required, as well as the risk of procedure-associated mitral regurgitation. In addition, the complexity of this technique prevented widespread adoption of the procedure, particularly with first-generation devices. In current practice, the femoral vein approach has largely been replaced by the femoral artery approach, which allows a simpler route of delivery. In this approach, a catheter is introduced through the groin into the femoral and iliac arteries to the aorta and then to the aortic valve. Limitations of this approach include the large diameter of the delivery catheter that must be accommodated by the iliac artery, and the tortuosity and atherosclerosis of the aorta in many patients who have aortic stenosis. The femoral vein, femoral artery, subclavian artery, axillary 25 artery, and ascending aorta approaches all have risks associated with vessel cannulation, including vessel wall injury, and in the case of retrograde. Compared with transfemoral approaches, transapical valve replacement has theoretical advantages associated with the straight-line approach to the aortic valve, including potentially reducing complications of aortic atheroembolic events, bleeding at the site of vascular access, and mitral valve damage. However, this technique carries the potential risks associated with surgical access and general anesthesia. Reported implantation success and 30-day survival rates are 89 percent and 89 percent, respectively, for the femoral artery approach, and 94 percent and 87 percent, respectively, for the transapical approach.

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The ubiquity and utility of this examination have even given rise, among some medical trainees, to a mentality that seeks the results of the echocardiographic evaluation before seeing the patient! Given its prominence in current practice, it is hard to conceive that the utility of echocardiography as other than an experimental curiosity really dates back only a few decades. Springing from the roots of sonar developed for marine surveillance, medical ultrasound assumed real utility in cardiology with the development of the M mode. The echocardiograms recorded using M mode required substantial special training for decipherment. The more recent introduction of Doppler techniques to the echocardiogram, the advent of transesophageal echocardiography, and the use of echo contrast illustrate the union of these disciplines in the service of cardiovascular diagnosis. It should be useful to trainees, sonographers, and cardiologists who practice echocardiography as a daily pursuit. The increasing facility of acquisition of echocardiograms raises the important question of the qualifications of the acquirer and interpreter. Echocardiography is the perfect marriage between anatomy and physiology, and an essential understanding of both is required of the echocardiographer. A substantial amount of this text is dedicated to the underlying physical and physiological principles. Solomon, and Rajesh Janardhanan Echocardiographic Assessment of Diastolic Function. The individual video clips are cited in the text along with the figure to which they correspond by number. Because the heart is a moving organ, and because echocardiography must additionally capture that movement, an understanding of echocardiography requires an understanding of both cardiac anatomy and physiology. This chapter reviews the basic principles of echocardiography and serves as a basis for understanding the specific disease processes discussed in the remainder of this text. The following equation defines the relationship between frequency, wavelength, and propagation velocity: c=. In M-Mode echocardiography, the resulting scanline is displayed along a moving paper sheet (or on a screen) so that time is recorded on the x-axis and distance from the transducer on the y-axis. The amplitude of the reflection is recorded as the intensity of an individual point along the scanline. Modern equipment, however, use electronically steered phased array transducers to generate multiple scanlines. Most ultrasound machines use between 128 and 512 phased array elements to generate pulses of ultrasound in an orderly sequence, with the result being similar to that which can be achieved with a mechanically rotating transducer, but with better spatial resolution. Although scanlines were visible in early ultrasound images, modern ultrasound equipment performs interpolation between scanlines to generate a smooth image without the appearance of scanlines. These reflections form the clearest boundaries on ultrasonic images and are termed specular reflections in which a significant proportion of the ultrasound energy is reflected back to the transducer. Finally, refraction occurs when ultrasound is reflected at an angle from the original ultrasound beam. All of these interactions with tissue are important in the ultimate image that is generated. Although ultrasound can easily traverse through bodily fluids, including water and blood, as well as most soft tissues, ultrasound does not pass easily through bone or air. This limitation represents a major problem in cardiac imaging because the heart is surrounded by the thorax (bone) and the lungs (air). The limit of the resolution of ultrasound is approximately one-half of the wavelength. Therefore, although higher frequency ultrasound can be used for highresolution imaging, its use will be limited because of decreased penetration. Because of decreased penetration, image quality can drop off dramatically when using higher frequencies in adults. In contrast, adults who have larger chest cavities will often require lower frequency probes. In fundamental imaging, the ultrasound transducer listens for the returning ultrasound at the same frequency at which it was emitted. The transducer can thus be set to listen at a frequency that is higher (by a multiple) than the original frequency. Obesity and chronic obstructive pulmonary disease are probably the two patient characteristics that affect image quality most.


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While Debra was the consummate mother, sister, daughter, and friend, she was also a courageous survivor and exceptional oncology nurse. Debra dedicated her life to raising awareness about survivorship and advocating for quality cancer care. If you find the Toolbox helpful, we encourage you to pass it on, when you no longer need it, to a friend or to your local library, community center, or house of worship, so that others may benefit from this information. The Spanish version of the Cancer Survival Toolbox was awarded the Bronze Certificate in the Patient Education Information class in the Other/Miscellaneous category. Public Relations Society of America Silver Anvil Award of Excellence, 2000 the Cancer Survival Toolbox won an Award of Excellence in the Corporate/Nonprofit Partnerships category of the Silver Anvil awards sponsored by the Public Relations Society of America. This award recognizes associations that propel America forward with innovative educational projects. The Toolbox received recognition in the category of Business and Social Innovation. The Crystal Obelisk is the only public relations industry award given solely for social responsibility. This publication may not be reproduced, in whole or in part, in any form, without prior written consent from the National Coalition for Cancer Survivorship. In 1986, it was your conviction that one day there would be a nationwide awareness of cancer survivorship, and that all those diagnosed with cancer would view themselves as "survivors," rather than "victims. Scherr, two-time cancer survivor, for compiling this handbook; to Ellen Stovall, Terry Campbell, for editing; and Tronette Anochie, Peggy Crowley, Donna Doneski, Steve Friedman, Eric Gordon, Rebecca Gregory, Stacia Grosso, Erika Ochoa, Bill Schmidt, Elizabeth Smart, Karen Beckham and Evniki Voyatzis for their additional support. With notable exceptions, few common medical conditions create as much fear, stigma and anxiety as cancer. They have learned that, while each one of us experiences cancer as an individual, there is some collective wisdom to be derived from what they have learned as a community of advocates for people who are living and dying well with cancer. Moreover, cancer comprises more than 100 diseases, and the conditions under which we experience cancer (our home, family, friends, finances, spiritual beliefs, employment, community) influence how we adjust to cancer as a life-changing experience. This handbook is, however, a primer intended to encourage and enable you to become an active participant as you deal with a diagnosis of cancer, no matter what your life circumstances. This is intentional, to reinforce the importance and purpose of the term self-advocacy. This handbook focuses on self-training steps and tools to assist and empower individuals dealing with cancer. If you are at the beginning, middle, or end of your decision-making about dealing with a diagnosis of cancer, the materials in this handbook will add value to your survivorship. Select the topic areas that relate to your situation and refer to this handbook at any time and in any order you choose. Share it with a friend, colleague, family member or health professional to broaden the circle of advocates who can be helpful with your diagnosis of cancer. You can think of these as your advocacy tools as you begin your journey of survivorship. The materials and tools in this handbook are based on the experiences of many survivors and are intended to help you "become your own best advocate. To paraphrase the Taoist philosopher Lao-Tzu, every journey begins with a single step. No matter where you are in your cancer journey, the step you take now may be your first to become more informed and feel more empowered to adjust to this diagnosis. Ideally, you are dealing with cancer with the support of many friends, loved ones and compassionate caregivers. Too often, people experience cancer in isolation, without financial or emotional support and with few resources to tap into. And remember, no matter where you are along the path of your survivorship, having good skills to negotiate and communicate your needs are some of your best weapons to use against cancer. The term advocacy is frequently used to encompass activities carried out in the name of supporting a cause. The dictionary defines advocacy as "active support, as of a cause, idea or policy.

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If images are acquired late after exercise, the heart rate may decrease substantially, giving time for any peak wall motion abnormalities to subside and, therefore, go undetected. The use of a supine bicycle machine may improve the timing of image acquisition, as images can be acquired at almost any time point during exercise and give true peak stress imaging. It is, therefore, believed that supine bicycle imaging may improve the sensitivity of testing over treadmill exercise. In the diagnosis of the coronary artery disease, stress to maximal 152 Bermudez and Chen. This 45-yr-old man with a history of hypertension and new right bundle branch block exercised for 12 min on a standard Bruce protocol, stopping secondary to fatigue. Heart rate and blood pressure at peak exercise was 179 bpm and 168/78 mmHg, respectively. However, in regard to viability testing, dobutamine echocardiography is primarily utilized over exercise stress in the identification, localization, and extent of viable myocardium. This cardiac inotrope provides stress through 1 receptor stimulation and increasing myocardial oxygen consumption. At peak levels, it is not uncommon to observe a drop in systolic blood pressure, owing to the mild vasodilatory effects of dobutamine. In contrast to exercise stress, this drop is not specific for severe coronary ischemia. Images are displayed in quad-screen format (the four views mentioned previously on one screen) for each stage and routinely digitized for interpretation. This protocol is often augmented when resting wall motion abnormalities are seen on the echocardiographic images. In general, the anterior, septal, and apical segments are supplied by the left anterior descending, lateral, and basal posterior segments by the left circumflex, and the inferior and posterior segments by the right Chapter 8 / Stress Echocardiography 155. Overall study was consistent with a large anterior and anteroseptal infarct with no significant peri-infarct ischemia. However, there can be considerable overlap in perfusion territories and depends on coronary dominance, which should be taken into consideration when interpreting segments that may belong to more than one coronary distribution. More recently, a 17-segment model has been developed that takes into account the true apex (see Chapter 5. Thickening is the primary measure of regional function, not myocardial motion itself. Normal myocardial segments should sufficiently thicken to a greater extent with stress. The stress images are then analyzed in addition to the size of the left ventricular cavity, 156 Bermudez and Chen. With increasing doses of dobutamine, augmentation of all segments accompanied by decrease in left ventricular cavity size up to a heart rate of 110 bpm. These findings were consistent with ischemia in the right coronary/left circumflex artery territory. Dyskinesia is defined by the presence of outward movement of the myocardium in systole in an area of akinesis. However, quantitative schemes have been developed in order to gain a more objective, standardized interpretation for stress echocardiograms. Viable myocardium that is more likely to recover function with revascularization is typical when a biphasic response is observed: hypokinesis at rest, improvement with low-dose dobutamine and worsening with high-dose dobutamine. Further, patients with chronic obstructive lung disease and hyperinflated lungs may impede the quality of echocardiographic images. In situations where endocardial border definition may be tenuous, the addition of intravenous echocontrast agents may help to better delineate 158 Table 2 Advantages/Disadvantages of Stress Echocardiography Bermudez and Chen Advantages Sensitivity and specificity comparable to exercise nuclear imaging Utility in diagnosis, prognosis, and risk-stratification Assessment of multiple parameters: systolic function, valvular function, and ischemia Widely available Portability Relatively inexpensive No radiation No need for iodinated contrast agents Disadvantages Highly dependent on sonographer and interpreter skills Difficult acoustic windows can limit imaging.

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Effect of antihypertensive monotherapy and combination therapy on arterial distensibility and left ventricular mass. The use of chronotherapeutics to achieve maximal blood pressure reduction during the Page 437 of 467 Final Report Drug Effectiveness Review Project early morning blood pressure surge. The use of sildenafil in patients with erectile dysfunction in relation to diabetes mellitus A study of 1,511 patients. Once daily compared with twice daily administration of slow-release diltiazem as monotherapy for hypertension. Antihypertensive effect of diltiazem in a slow-release formulation for mild to moderate essential hypertension. The Diltiazem Different Doses Study-a doseresponse study of once-daily diltiazem therapy for hypertension. Ambulatory blood pressure profiles in essential hypertensives after treatment with a new once daily nifedipine formulation. Morning versus evening amlodipine treatment: Effect Calcium Channel Blockers Update #1 on circadian blood pressure profile in essential hypertensive patients. Hyperhomocysteinemia in preeclampsia is associated to higher risk pressure profiles. Macrophage subpopulations in gingival overgrowth induced by nifedipine and immunosuppressive medication. The effect of high dose losartan on erythropoietin resistance in patients undergoing haemodialysis. Calcium channel blockers and myocardial infarction: A case-control study in a Japanese hospital. Efficacy and tolerability of amlodipine in patients with mild to moderate hypertension. Effects of angiotensin converting enzyme inhibitor and calcium antagonist on endothelial function in patients with essential hypertension. A randomised trial to compare the efficacy and safety of Felodipine (Plendil) and Nifedipine (Adalat) retard in patients with mild-tomoderate hypertension. Effect of amlodipine and cilazapril treatment on platelet Ca2+ handling in spontaneously hypertensive rats. Effect of nifedipine monotherapy on platelet aggregation in patients with untreated essential hypertension. Effect of amlodipine versus felodipine extended release on 24-hour ambulatory blood pressure in hypertension. Immediate and long-term cardiovascular effects of nisoldipine in normotensive and hypertensive subjects. Antiarrhythmic effects of azimilide in paroxysmal supraventricular tachycardia: Efficacy and dose-response. Amlodipine lowers blood pressure without affecting cerebral blood flow as measured Page 439 of 467 Final Report Drug Effectiveness Review Project by single photon emission computed tomography in elderly hypertensive subjects. Anti ischaemic efficacy of amlodipine vs nifedipine in the treatment of patients with stable exertional angina. Twenty-four-hour antihypertensive efficacy of felodipine 10 mg extended-release: the Italian inter-university study. The effects of isradipine and alpha-methyldopa on exercise haemodynamics in hypertensive patients. Nifedipine versus expectant management in mild to moderate hypertension in pregnancy. Effect of losartan and amlodipine on proteinuria and transforming growth factor-beta1 in patients with IgA nephropathy. Randomized, placebo-controlled study of the effect of verapamil on exercise hemodynamics in coronary artery disease. Nisoldipine tablets once daily versus nifedipine capsules three times daily in patients with stable effort angina pectoris pretreated with atenolol. Heterogeneous effect of calcium antagonists on leg oedema: a comparison of amlodipine versus lercanidipine in hypertensive patients. Effect of diltiazem and digoxin on heart failure patients with fast atrial fibrillation.

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Report any bladder symptoms, especially blood in your urine, to your healthcare provider. A condition called osteoporosis is when the amount of bone is decreased and the structural integrity of the bone is impaired. Resistance exercises such as light weight lifting also help to build strong bones and are especially important for upper body bones including the arms and shoulders. Be sure to discuss your individual health status with your healthcare provider before starting any new exercise program. This imaging study measures bone density and can be used as a baseline with follow-up scans to measure changes. The best person to discuss your individual risk of your specific cancer recurring is your oncologist. Many factors can affect cognitive function including fatigue, side effects of medication, depression and anxiety. Although it may be difficult, it is very important to talk to your healthcare provider about your concerns in order to get to appropriate referrals and treatments. Dental health Patients who have undergone cancer treatment may have some increased risk for dental abnormalities. Dry mouth, decreased saliva production, gum disease and changes in sense of taste and smell are often reported with both chemotherapy and radiation. Many survivors feel more vulnerable when active treatment is done and they are not seeing their healthcare team as often. Sometimes that can mean learning new relaxation or coping skills or improving upon the ones that you already have. Examples of relaxation strategies are meditation, exercise, journaling, getting a massage or talking to a friend or family member. Fertility There are some chemotherapy drugs and radiation to the reproductive area that may affect your fertility. Women interested in their fertility status should keep track of menstrual cycles and report any changes to their healthcare provider. Men interested in maintaining fertility should have semen analysis periodically over time, as resumption of spermatogenesis can occur up to ten years post therapy. There are many ways to determine your fertility status with the help of a fertility specialist, reproductive counseling, gynecologic evaluation, endocrine evaluation and/or laboratory values. Problems with digestion, such as lactose or gluten intolerance, impaired absorption of nutrients, flatulence (gas), abdominal distention, diarrhea and constipation are also common. Many cancer survivors have concerns with gaining or losing more weight than they would like. Some of these symptoms come and go, many of these conditions begin years after completing treatment and some get worse over time. Drinking plenty of fluid helps absorption of nutrients and to move contents along to prevent constipation and irritation. Gentle exercise such as stretching, walking, yoga and swimming can be of significant help for bowel concerns. If symptoms are bothersome or persist, talk to your health care provider for evaluation and assistance. Hearing Patients treated with heavy metal agents, such as cisplatin/carboplatinum, are at risk for high-frequency hearing loss. Patients are encouraged to have their hearing monitored yearly with a history and physical examination. A baseline audiogram should be performed and, if abnormal, followed yearly until stable. Heart health Most cancer survivors do not develop heart problems; however, certain types of cancer treatment can sometimes impact heart health.

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The valve of choice in elderly patients and its influence on quality of life: a longterm comparative study. Mid-term comparative follow-up after aortic valve replacement with CarpentierEdwards and Pericarbon pericardial prostheses. Ten-year echocardiographic and clinical follow-up of aortic CarpentierEdwards pericardial and supraannular prosthesis: a case-match study. Valve-related complications in elderly patients with biological and mechanical aortic valves. Mechanical versus biological isolated aortic valvular replacement after the age of 70: equivalent long-term results. Long-term outcome after biologic versus mechanical aortic valve replacement in 841 patients. Very longterm survival implications of heart valve replacement with tissue versus mechanical prostheses in adults <60 years of age. Are allografts the biologic valve of choice for aortic valve replacement in nonelderly patients? Comparison of explantation for structural valve deterioration of allograft and pericardial prostheses. Stented versus stentless bioprostheses in aortic valve stenosis: effect on left ventricular remodelling. Tilting-disc versus bileaflet mechanical prostheses in the aortic position: a multicenter evaluation. Criteria Used To Assess the Quality of Systematic Reviews Included for Question 2 the following 10 criteria were used to assess the quality of systematic reviews included for Question 2 (evaluating comparisons of various types of conventional heart valves). Consider and rate 2 components: (a) Search methods described in enough detail to permit replication? Consider and rate 2 components: (a) Were the criteria specified clearly enough to permit replication? Consider criteria related to study population, intervention, outcomes, and study design. Were the primary studies evaluated for quality, and were quality assessments done appropriately? Consider and rate 2 components: (a) Did 2 or more independent raters abstract data? Consider and rate 2 components: (a) Was there a check for heterogeneity statistically or graphically? Consider whether any of the following methods were employed: Funnel plots, test statistics, or search of trials registry for unpublished studies. Peer Reviewers the Duke Evidence-based Practice Center is grateful to the following peer reviewers who read and commented on a draft version of this report: Thanos Athanasiou, M. Designations used by companies to distinguish their products are often claimed as trademarks. If professional advice or other expert assistance is required, the services of a competent professional should be sought. The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Cover design by Andy Meaden Set in 8/10pt Frutiger Light by Laserwords Private Limited, Chennai, India 1 2014 Contents Preface, vii 1. Environmental and genetic conditions associated with heart disease in children, 73 3. A healthy lifestyle and preventing heart disease in children, 329 Additional reading, 373 Index, 375 v Preface Since the first printing of this text 50 years ago, pediatric cardiac catheterization, echocardiography, and magnetic resonance imaging have developed and less emphasis has been placed on the more traditional methods of evaluating a cardiac patient.


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